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104 Cards in this Set
- Front
- Back
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ideal psy drug should act directly on the --- mechanish of the ----- or ------ to cure or alleviate
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pathogenetic
symptom disorder (but it's unknown) |
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ideal psy drug should be effective -----
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rapidly
sometimes not effective and rapid |
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ideal psy drug should benefit most or all pts for who it's indicated
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only works on 70% for antipsy
and 50% for antidepressants |
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ideal psy drug should not allow --- to develop
show be ----- and lack potential for creating ----- |
tolerance
nonhabituating dependence have increased tolerance and addiction |
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ideal psy drugs should have min ----- in the tx range and have low incidence of 2ndary ----
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toxicity
se |
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ideal psy drugs should not be ---- in overdose and be adaptable in both--- and ----
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lethal
inpatients outpatients |
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ideal psy drugs should not impaire any ---, ---, or --- fxs
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cognitive
perceptual motor |
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which drugs have the most se
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MAOI
TCA TAP |
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which drugs have the least SE
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SSRI
NSRI NSSRI ATAP |
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dx of schizophrenia:
at least 1 ---- symptom plus - or more of the other symptoms |
positive
1 |
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how long must you have the symptom to be dxed w/ schizophrenia
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over 6 months
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dx of schizophrenia involoves no evidence of --- or --- disorder
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drug induced
mood |
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positive symptoms
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hallucinations
delusiions disorganizede speech/formal thought disorder disorganized/bizarre/catatonic behavior |
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neg symptoms
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alogia
avolition/amotivational affective blunting anhedonia |
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cognitive defects symptoms
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tangentiality
incoherance looseness of associations neologisms |
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domain of diorganized/bizarre/catatonic behavior
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positive symptoms
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domain of disorgainzed speech/formal thought disorder
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positive
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DA hypothesis of psy disorders
too much DA in the ------- |
mesolimbic
from NAC to VTA |
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da hypothesis of psy disorders
too little DA in the ---- systme |
mesocortico system
vta to frontal cortex |
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too little da inthe mesocortical system can lead to --- symtoms
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mesocortico
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sertonin hypothesis:
too much/little 5HT inhibiting ---- cortex |
too much 5ht
prefrontal this leads to an imbalance in DA |
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glutamate hypothesis:
loss of --- receptors |
NMDA
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neurodevelopment hypothesis:
abnormal --- development involved w/ neuronal ------ and ---- |
feta
migration connection |
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pts lacking connections tend to have --- ventricles
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larger
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pt's might have neuro----
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neurodegeneration
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why do meds take a while to tx psy
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cuz need to reconnect
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the mesolimbic is the --- --- area to the --- ----, ----
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ventral tegmental area
nucleus accumbens amygdala |
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the mesolimbic is involved in ----, --- psychosis
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addiction
amphetamine |
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if the mesolimbic becomes hyperfunctional what occurs
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pos symptoms
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mesocortical is the --- ---- area to the --- ---
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ventral tagmental area
frontal cortex |
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mesocortical execute functio fothe brain due to --- feedback to Nac
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inhibitory
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mesocortical pathway may become hypofunctional which may lead to ----
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neg symptoms
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where the motor control
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nigrostriatal pathway
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nigrostriatal pathway is the basis of ------ se
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motor-related
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what's involved in endocrine fx
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tuberoinfundibular
tuberhypophyseal |
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the tuberoinfundibular and tuberohypophyseal are the basis for ---- related SE
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prolactin
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what usu inhibits prolactin
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DA
so when blocked. .. increas in prolactin |
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what can an increase in prolactin cause
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menstrual irregularities
gynecomastia |
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ctz is located in the --- ---
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area posterna
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t/f
block da can lead to emesis |
f
antiemetic effects |
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how to avoid eps
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slowly taper after 1 yr
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drug tx works best for ---- episodes of --- symptoms
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acute
positive |
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which eps irreversible
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tardive dyskinesia
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the sedative action and the cognitive dysfunctions due to
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anticholinergic
antihistminic effects |
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if you block the 5HTA/C receptor what occurs
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inhibitor of DA. . . less DA
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high potency meds will have what type of se
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parkinson's
cuz higher affinity for DA |
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the low potency meds wil lhave have what type of SE
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muscarinic
adrenergic histiminic other SE |
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normal there's a balance btw DA and --- that prevents parkinson's
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muscarinic
so when you decrease and the higher muscarinic will lead to parkinson se you'll also have to block the muscarinic to to restore balance |
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w/ D2 like receptor subtype antagonism you decrease --- symptoms via decrease NAC DA signaling
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positive
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w/ D2 like receptor subtype antagonism you decrease positive symptoms via decrease --- DA signaling
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NAC
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how will the neg symptoms worsen
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by decreaseing PFC signaling
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se due to antagonism of d2-like
intially there's -------- |
parkinson like symtoms
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d2 like antag leads to --- --- w/ prolonged tx
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tardive dyskinesia
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d2 like antag can lead to gyencomastia due to increased ---- due to -- blockade
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prolactin
D2 |
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alpha-1 antag can lead to these se
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dizziness
postural hypotension relfex tachycardia |
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antimuscarinic can lead to
--- vision --- mouth constipation --- retention |
blurry
dry urinary |
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antimuscarinic can relieve/worsen intital parkinsonism, relieve/worsen tardive dyskinesia
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relieve
worksen |
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what can lead to sedation and weight gain
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blocakge of histamine receptors
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too much antagonist can lead to an ---- of receptors
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upregulation
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too much antagonist can also lead to
-----in 2nd messengers ---- metabolism of Da ----synthesis/release of DA |
increase
decrease increase |
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major limiting factor for tx use of antipsychotics
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eps
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parkinson' like se
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catatonia
motor rigiditiy tremor |
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which 5HT leads to weight gain
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combo of 2A and 2C
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dystonia can lead to --- muscle contractions that cause ----- and uncontrolled movements of the face, neck and -----
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involuntary
bizarre tongue |
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severe restlessness and agitation
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akathisia
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when are movement continuous for tardive dyskinesia
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during waking hrs
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who's more prone to tardive dyskinsia
men or women |
women
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how long can it take tardive dyskinesia to decrease
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2-5 yrs
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what can increase TD sensitivity
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anticholinergics
L-dopa |
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s/s of TD
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chewing
licking movements tongue protrusions limb movements |
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td possibly b/c:
continuous exposure to --- antagonist led to increased --- number or increased --- to DA |
DA
receptor sensitivity |
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another theory of td
some d2 receptors cause --- and --- while others cause parkinsonism |
dyskinesias and dystonia
parkinsonism and akathisia |
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td can be due to decreased striatal -- acitivity
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GABA
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abnormal d2/d- ration can cause td
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d1
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d1 agonists cause more TD if --- receptors blocked
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D2
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---- ---- decrease dose until symptoms decrease
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drug holidays
may return more severe even at lower dose |
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tx of td
--- or switch to an atypical antipsychotic |
d/c
lower but not zero (switching) |
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what can help w/ reducing
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cholinergic agonist
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which receptors more specifically involved in eps
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D2
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atypical antipsychotics have -- to --- x less potent for --- and ---- se
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eps
prolactin |
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atypical antipsychotics have more efficacy towards --- and -- symptoms
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negative
cognitive |
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aytpical have less ---, ---- impairment, and ----
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sedation
cognitive catalepsy |
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atypical have less --- --- w/ prolonged use
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td
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se of atypical
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weight gain
dm increased cholesterol heart probs |
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why less sedation w/ atypical
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cuz they are more selective
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possible mech of atypical
limbic or cortical D- and D- receptors vs ----- D2 |
D3 and D4
striatal |
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mech for atypical
blockade of --- ---- 5Ht-2 receptors |
frontal cortex
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blockade of frontal cortex 5HT receptors stops --- inhibition of mesocortical ----
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Serotonin
dopamine (decrease neg symptoms) |
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which se occurs mainly at d2 receptors
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akathisia
eps |
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what % of D2 occupancy needed for tx w/ typical and atypical
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typical: 70%
atypical: 20% |
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dose response separation btw --- and --- effects is possible mechanism of atypical
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therapeutic
motor |
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atypical might need contribution from ---- occupancy
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5HT2
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se of atypical
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weight gain
impaired glucose tolerance hyperlipidemia |
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clozapine se
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1% incidence of agranulocytosis
monitor wbc q week |
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ziprasidone, sertindole, and thioridazine se
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qt prolongation and risk of sudden death
binds to K channel subtype |
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risperidone se
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increased risk of stroke
some eps gynecomastia |
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olanzapine se
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increase risk of stroke
worst weight gain |
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aripiprazole se
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increase risk of stroke
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s/s of malignant syndrome
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catatonia
stupor fever unstable bp myglobinemia |
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mech of malignant unknown but r/t --- receptor antagonism
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DA
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tx of malignant syndrome
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stop tx and give
dantrolene bromocriptine |
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which will have more malignant syndrome
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typical
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bromocripitne have ---activity
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agonist
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partial agonist restore transmission needed but block where needed. ..
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balance
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